P - 75788REQUEST FOR ELECTRICAL INSPECTION �°`
1� J 3�- 2 31 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.elecrizcity.state.mn.us
Desaibe -using the back of the white copy'rf nec�sary - the vwork cove by this requ�st:
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GENERAL FEES Outdaor Liahtina SYandard (� �7
I SERVICES / POWER
ALARM, COMMUNICATION, REMOTE CANTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A pa�atus @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units �$50 Per Unit
Each Additional Unft @ $25
OTHER AD
Liahtina Retrofrt an $25 �r F
�pection @ $30 erHour
;pecGon @ $.31 per Mde
4LLATION MAY BE-ORDERED
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19382316
Traffic Sipnal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspedion Trips Each Dwellurg Unit @$BO
Addfional Insaecfion Trios (�D $20
TOTALFEE
total fee is $20) , sb
I hereby eertify fhat I inspeded the electriral inslallatlon desm'6ed herefn on tlre datav stated:
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NNECTED IF NOT COMPLETED WITHIN 12
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/' �on Other Than Rough-In: � Ready Now N Call
D(,p You must call the inspector when readyl Dete Ready.
I ce 1 am the LICENSED CONTRACTOR ❑ COMPRNY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Add
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ced Signeture ntra Owner Pe rming Installation) Please Provide Tvwo (2) Phorre Niunbeis Induc�ng Area Code
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